Georgia CommonsHB 961: Surprise Billing Consumer Protection Act; insurance coverage for certain out-of-network ambulance transportation service; provide
Last action March 6, 2026 · Senate Read and Referred
House Bill 961 would require Georgia health plans to cover out-of-network ground ambulance rides and set a minimum reimbursement rate for ambulance providers, so patients are not left to cover the full bill themselves.
The summaries below were written by an AI model (claude-sonnet-5) from the text of the bill and are not part of it. Quote the text, not the summary. The stored text is the Comm Sub version, the latest LegiScan holds.
In plain language
Currently, Georgia's Surprise Billing Consumer Protection Act (O.C.G.A. Chapter 20E of Title 33) does not guarantee coverage for ground ambulance transportation, meaning patients could be billed directly by out-of-network ambulance providers. This bill rewrites Code Section 33-20E-23 to change that. Under the bill, a health plan must treat emergency ambulance transport as a covered service when a first responder or medical practitioner requests it, or when the transport was medically necessary. If there is no local government contract setting a reimbursement rate, insurers must pay out-of-network ambulance providers at least 300 percent of the Medicare reimbursement rate. Patients would only owe their normal copayment, coinsurance, or deductible, capped at what they would pay for an in-network ambulance. Insurers must pay clean claims within 30 days or explain any denial or request more information within that time.
What the bill does
- Requires Georgia health plans to cover emergency ground ambulance transportation requested by a first responder, medical practitioner, or when medically necessary.
- Sets a minimum reimbursement rate for out-of-network ambulance providers, defaulting to 300 percent of the Medicare rate when no local government contract sets a different rate.
- Caps what patients pay in copayments, coinsurance, or deductibles for out-of-network ambulance service at the same level as in-network service.
- Bars insurers from billing patients further once they pay the ambulance provider, aside from normal copays, coinsurance, or deductibles.
- Requires insurers to pay a clean (properly documented) claim within 30 days or send written notice of denial or a request for more information within that time.
- Defines key terms including ambulance provider, clean claim, covered service, emergency transport service, first responder, and medical necessity.
Who it affects
Georgians who use emergency ground ambulance services, health insurers and health plans operating in the state, ambulance providers (including local government-run ambulance agencies), first responders such as firefighters, paramedics, EMTs, and police, and county and municipal governments that may set local reimbursement rates by ordinance.
Why it matters
Patients who call or need an out-of-network ambulance would be protected from large surprise bills, since insurers would have to pay ambulance providers directly at a guaranteed minimum rate and patients would only owe normal cost-sharing amounts, similar to what they'd pay for an in-network ambulance ride.
Key provisions
- Section 1 rewrites O.C.G.A. § 33-20E-23, replacing language that left ground ambulance costs entirely to the patient's financial responsibility.
- Subsection (a) defines ambulance provider, clean claim, covered service, emergency transport service, first responder, and medical necessity for purposes of this Code section.
- Subsection (b) requires health plans to treat emergency ambulance transport as covered when requested by a first responder or practitioner, or when medically necessary.
- Subsection (c) sets the minimum reimbursement rate: a local government-negotiated rate if one exists, otherwise 300 percent of the Medicare Part A or B rate for ambulance services.
- Subsection (d) states that once an insurer pays the ambulance provider, the patient owes nothing further except normal copayments, coinsurance, or deductibles.
- Subsection (e) caps out-of-network ambulance copayments, coinsurance, or deductibles at the same level charged for in-network ambulance service.
- Subsection (f) requires insurers to pay clean claims within 30 days or, for incomplete claims, notify the ambulance provider within 30 days of a denial or request for more information.
- Section 2 repeals conflicting laws.
From the bill
“The minimum allowable reimbursement rate under any healthcare plan other than a state healthcare plan for covered service to an out-of-network ambulance provider shall be the rate agreed to by contract with or through passage of an ordinance, resolution, rule, or regulation”
“the minimum allowable reimbursement amount shall be 300 percent of the reimbursement rate under the Medicare program, Part A or B of Title XVIII of the federal Social Security Act”
“No later than 30 days after the receipt of a clean claim for covered service, an insurer shall remit payment for such service directly to the ambulance provider and shall not remit any payment to a covered person.”
Status timeline
- Senate Read and Referred (Senate)
- House Passed/Adopted By Substitute (House)
- House Third Readers (House)
- House Committee Favorably Reported By Substitute (House)
- House Second Readers (House)
- House First Readers (House)
- House Hopper (House)
Sponsors
- Alan Powell (R, HD-033)
- Michelle Au (D, HD-050)
- Rick Jasperse (R, HD-011)
- Mary Oliver (D, HD-084)
- Sharon Cooper (R, HD-045)
- David Wilkerson (D, HD-038)
Votes
- House voteMarch 4, 2026
174 yea, 1 nay (1 not voting, 1 absent)
Topics
- surprise billing
- ambulance services
- health insurance coverage
- medical billing protections
- emergency medical services